Wilms tumour and renal malignancies: Viva

This is a branching oral built to probe the reasoning that holds the histology and the staging at the centre, and to expose the candidate who has memorised the headline without the corners. The questions escalate from the framing to the imaging, the staging, and the definitive management, with the deliberate probes into the pitfalls of the tumour spill and the missed thrombus. ^[1]

Opening question: framing the problem

The examiner opens with the history and the examination and asks: how do you frame this problem in a single sentence, and what is your first priority? ^[1]

A strong answer names the renal tumour, states that the painless abdominal mass that does not cross the midline in a three-year-old is a Wilms tumour until the imaging settles it, and identifies the hypertension as the accompanying feature. The first priority is the imaging that confirms the renal origin and excludes the tumour thrombus, and the avoidance of the biopsy. ^[4]

Model answer. This child has a renal tumour, almost certainly a Wilms tumour, until the imaging settles it. The smooth, firm, flank mass that does not cross the midline in a three-year-old, with the hypertension, is the classic presentation. My first priority is the ultrasound with the Doppler of the cava, the staging, and the urgent referral to the specialist centre, with the biopsy avoided in the typical case. ^[1]

Probe one: the imaging and the staging

The examiner presses: what imaging do you arrange, and why do you image the cava before the surgery? ^[9]